thriveyouth hd
Dear Parent/Legal Guardian,
We're excited to share that your child has the opportunity to participate in the upcoming
THRIVE Crossover Youth Event!
Students will participate in age-appropriate THRIVE lessons that help build important
life skills. These sessions focus on developing healthy relationships, strengthening
communication skills, building character, and learning how to make positive choices at
school, at home, and with friends. Our curriculum takes a positive youth development
approach, helping students build on their strengths and focus on their goals and
aspirations.
We believe parents and guardians are essential partners in a young person's growth.
Students will be encouraged to continue conversations at home about topics discussed
during camp. All instruction is medically accurate, age-appropriate, and inclusive of all
students.
Please review, sign, and return the attached forms at your earliest convenience. We
truly appreciate your partnership and look forward to connecting with you throughout
this experience.
If you have any questions or concerns, please don't hesitate to contact us at (760) 243-
4343.
We're looking forward to an incredible camp!
Sincerely,
THRIVE Youth Team
15260 Nisqualli Road Victorville, CA 92395
Office: (760) 243-4343
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THRIVE Youth Program - Consent & Information Form
Student Information:
Name:
*
DOB:
*
-
Month
-
Day
Year
Date
Age:
*
Gender:
M
F
Race:
Hispanic/Latino
Non-Hispanic/Latino
Ethnicity:
White
American Indian/Alaska Native
Native Hawaiian/ Pacific Islander
African American
Other/Decline to state
Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Street & Apt # City State ZIP
School:
*
Grade:
*
Student Email:
example@example.com
Has student attended a THRIVE event before?
*
Yes
No
If yes, when?
Student Confidentiality Statement:
THRIVE Youth HD staff and mentors are committed to building a trusting relationship with you. What you share with them will remain confidential. However, if you disclose anything involving potential harm—such as abuse, self-harm, or threats to others—they are legally required to report it to the appropriate authorities.
*
understand confidentiality and the limits to this confidentiality.
Student Signature:
*
Date:
-
Month
-
Day
Year
Date
Parent/Legal Guardian Info:
Name:
*
Email:
*
example@example.com
Relationship:
Mother
Father
Other
Phone:
*
Format: (000) 000-0000.
Format: (000) 000-0000.
Emergency Contact:
*
Relationship:
Phone:
*
Format: (000) 000-0000.
Students who consent may receive additional support such as after-school activities, mentoring, referrals to community services, and support groups. To help us connect your student with the right resources, we will conduct a basic needs assessment and interest survey. All information will remain confidential and used solely to determine service needs and provide appropriate support.
*
I do wish to receive additional services through THRIVE Youth HD
I do not wish to receive additional services through THRIVE Youth HD, but still wish to participate in the program.
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Cohort#
Student Manual Issued:
THRIVE Youth Program – Consent & Information Form
Parent/Legal Guardian Consent:
By signing below, I/we give permission for THRIVE Youth HD to photograph and/or record my student during program activities. These images may be used in promotional materials, including brochures, websites, and media coverage.
I/we have read, completed, and understand this consent form, and authorize my student's participation in the program. I understand that my student is expected to attend all 13 curriculum sessions or an approved alternative.
THRIVE Youth HD staff and mentors are committed to building trust and maintaining confidentiality, following all applicable policies and legal guidelines.
Signature of Parent/Legal Guardian)
*
(Date)
-
Month
-
Day
Year
Date
Please Print: Parent/Legal Guardian)
*
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